Proposed PSP causes, for research

Proposed causes of Progressive Supranuclear Palsy (PSP)

Dr. Barry Lieberman, D.C., A.C.N.
Los Angeles

As you may know, the current stated opinion regarding PSP, Progressive Supranuclear Palsy, is that there is no known cause and no known cure. I am a clinician in Los Angeles who fortunately had the opportunity to intervene in one person's experience with the course of this rare progressive neurological disease, even though the patient's family were biased against any more than my initial recommendation for care: only 5 follow-up evaluations in total. So in such an extremely limited clinical window, we could only expect a minimal move toward our initial goal to possibly slow the disease's known progressive course of neurodegeneration.

Progress toward our goal was measured by our observation of any positive changes compared to her initial physical tests. Additionally, to track progress, we obtained a broad array of new blood test values that were intended to be correlated with a subsequent set of blood test values after our initial phase of care was given, but due to bias from the patient's family, that subsequent blood test never happened.

Unfortunately, regardless of any clinically observed progress, the patient's husband believed only in failure, and his blame was on my initial course of care, but not on any of the patient's previous and concurrent long-term medications, nor any long-term treatments prescribed by other doctors, because, as the patient's husband said, "they aren't promising anything."

With conventional medical interventions, the disease of PSP is presently considered just as predictably progressive as it was when the famous actor Dudley Moore first presented with symptoms of this disease in February of 1998. As far as I know, there is no advancement in therapies and certainly no new drugs that have shown any promise at all for those suffering with this progressive neurological disease called PSP. Any drug therapy used today is strictly to hide as many symptoms as possible while the PSP disease continually progresses on its known course. Eventually this will fail. My patient stated that her doctor told her to try to keep using her walker and keep out of a wheelchair for as long as she could, because once she would start using a wheelchair she would never get out.

According to Dr. Lawrence Golbe, UMDNJ-Robert Wood Johnson Medical School,
New Brunswick, NJ:
"[PSP] typically produces a chair-bound state 5 or 6 years into the illness." (1) A lady from Greece wrote to tell me her mother didn't last 4 years with PSP.

Furthermore, the description of one of the acute-care drugs that was prescribed for her, "Namenda" (Memantine) says that it might decrease brain plasticity. Decrease brain plasticity? This is a clear contraindication for a person with PSP, or any chronic neurodegenerative condition affecting the brain. That is, of course, unless the prescribing doctor fully believes that the patient has no chance anyway. If they believe the patient just has no chance, then it explains why they wouldn't bother to care about about brain plasticity. In the face of such a chronic disease, brain plasticity is all she's got!

I discussed this stated side effect of Namenda with my patient and spouse, and asked them to mention it to her prescribing doctor, but at our next visit they said their doctor suggested she keep taking that drug (and they're "not promising anything?"). Let me tell you what her other doctors are promising: they're promising certain failure.

Brain plasticity is the healing and repairing mechanism of the brain.

Brain plasticity is the inherent potential ability of the brain to remodel and rebuild. Current scientific literature supports the idea that the potential for brain plasticity can be influenced with clinical nutrition.

Regarding NMDA receptor antagonists, which is what Namenda is: "blockade of synaptic transmission mediated by NMDA receptors hinders neuronal survival." But you WANT neuronal survival. Neurons are nerve cells. We want to ENHANCE neuronal survival any way we can, otherwise you get progressive brain degeneration with no way to prevent memory loss, or neurodegeneration. These concurrent prescriptions guarantee failure of alternative therapeutic interventions, i.e., any alternative therapy, alternative support, or alternative to failing treatment, because these prescription treatments block brain plasticity and hinder nerve survival. Don't believe the commercials about these drugs that you see on TV!

I saw the patient, a woman of 69 years, approximately once every 2 weeks for 5 visits. At each visit, I examined her and observed the numerous neuromuscular reactions elicited during my examination. This is a key component of my approach. The purpose of these repeated tests are to observe if the neuromuscular reactions are normal or not, and to observe what natural medicine appears to have a normalizing influence on the mechanisms behind those reactions, in real time (critics and skeptics, see below).

By observing and evaluating the meaning of the multiple elicited reactions during the physical testing process, I was able to recommend the best course of supportive functional nutrition that she needed. Upon follow-up visits, the re-evaluation of the neuromuscular reactions can be used as a measuring tool for the success, or not, of the normalizing factors that were introduced at the previous visit. To observe increasingly more normal reactions upon follow-up visits with repeat testing suggests better functioning of the core systems which play some role in each specific reaction—and increasingly more normal is what I was observing with this patient's reactions.

"Increasingly more normal is what I was observing with this patient's reactions"

This is a functional medicine approach. Part of our goal is to influence epigenetics, when these tests indicate that doing so would be beneficial. What this means, in more simplistic terms, is that "detoxication," (supporting purification mechanisms) may be one of the major factors needed for greater function. The premise here, that appears to be supported by the latest scientific research, is that epigenetic mechanisms can be at the core of the capacity of the CNS to regenerate. *
* R. Puttagunta et al. 'PCAF-dependent epigenetic changes promote axonal regeneration in the central nervous system', Nature Communications (2014)

If I would have known about infrared video oculography and if it were available locally, I would have ordered that test at the outset of my care to objectively monitor any progress under my care; where "progress" would be a positive outcome. As Dr. Stephen Reich of the Johns Hopkins School of Medicine, Baltimore, MD once wrote: "at the New Jersey Neuroscience Institute. Using a technique
known as infrared video oculography, they were able to measure the speed
of Mr. Moore's eye movements. This demonstrated that his vertical eye movements were very slow and this is one of the earliest features of PSP,
but often difficult to appreciate clinically."

I didn't have that test at my disposal, but I did run a full panel of blood tests at the outset of care and evaluated the lab results from a functional medicine perspective. All this is background for my own clinical observations regarding a women with a diagnosis of PSP.

Through my clinical testing, I found that she had a very high level of oxidative stress, as revealed by her need (derived through repeated testing) for one particular supplement (Glutathione Recycler) at a level of 4 per day for several weeks (reevaluations were done at 2 week intervals). Comparatively, this is the highest pill requirement per day, for that long, that I had ever seen for this particular clinical nutrition supplement. This finding coincides with current science, which shows that oxidative stresses deplete levels of glutathione needed for efficient NMDA function at the NMDA receptors of the brain. You don't need to stimulate those receptors, you need to protect them!

The following factors ARE what I think must be considered in any person diagnosed with PSP, as their combination may be the true underlying keys to the mechanisms that could cause PSP. Addressing these core factors, naturally, not with drugs that cover-over symptoms, is the key.

Total cholesterol lower than 150 units, and still using cholesterol lowering drugs

Any Thyroid Condition requiring Thyroid hormones
Sub Optimal Thyroid markers such as:
Total T3 less than 100 ng/dL, Free T3 less than 3.0 pg/ml, reverse T3 out of range

Please Note: Several people have contacted me regarding PSP and a Thyriod diagnosis was part of the picture. Thyrioid hormones drive brain function. Thyroid medicines only correct one marker related to thyroid hormone balance. The rest of the lab markers for thyroid make a big difference, yet they are not routinely checked.

Please also note that Amiodarone Induced Hypothyroidism (AIH) should definitely be evaluated any time a person is taking that drug longer than just temporarily. Do not overlook this.

CRP (c-reactive protein) above 3.0 mg/L

any indication of immune system activation: WBCs >8.0, or infection: WBCs >11.0
Please note: vaccines activate the immune system, that's what they are desigened to do.

any indication of chronic immune depletion, where WBC count is less than 5.0

regular use of antacids of any kind; prescription, or OTC; Tums or Rolaids included

diuretic use

delayed muscle performance responses, as elicited in our in-office examination that we do
in Los Angeles

neuroinflammation (brain on fire) as documented in advanced imaging studies

any indication of oxidative stress overload (can be as simple as an oxidata urine test)

I propose that these factors ARE the key players in the development of PSP, and that the prevention and correction of these factors (not the covering-over of symptoms by more pharmaceuticals) could be the only way available to stop the progression of this rare neuro-degenerative disease known as progressive supra-nuclear palsy. Don't let any doctor tell you that the mechanisms behind these test results have nothing to do with brain function. They ALL do.

Even top expert medical doctors, or neurologists are not looking at these factors as causative of PSP, because the textbooks still say that PSP has no known cause and no known cure. Misguided PSP research looks for drugs that can only cover-up some symptoms of the disease, without affecting the disease itself. In PSP, such a symptom is difficulty in swallowing liquids. The doctors write prescriptions of a drug that slows down saliva production to counteract this symptom. Is that all we've got? With that kind of treatment, anyone diagnosed with PSP really doesn't have a chance. That is a terribly hopeless fate. Why is there no investigation into the causation of this disease? Perhaps it would be too embarrassing to discover that the prescription drugs themselves, that were administered for all those years, caused the underlying mechanisms for the initiation of the condition in the first place; the causes.

I would be willing to conduct new clinical research investigating PSP. If you are interested in funding such a research project, please let me know.

If you are caring for a person that was diagnosed with progressive supranuclear palsy (PSP) and would like me to help put this together for you in a plan, to possibly slow the progression of the disease, or to possibly regain some function, I would be willing to be part of your medical team, so please contact me.